BACKGROUND: Difficulty of sleeping is a predominant complaint among the elderly occurring in 12-25 percent of healthy seniors. Typical response of most physicians is to provide medications like benzodiazepines. Owing to the side effects of these drugs, alternatives to pharmacologic treatment such as music therapy abound. Music therapy is safe, affordable and may complement other non-pharmacologic interventions, yet there is paucity of evidence from controlled trials to support its efficacy.
OBJECTIVE: To determine the efficacy of music therapy in improving quality of sleep among elderly patients with primary insomnia as compared to 1) Zolpidem and 2) Sleep hygiene using the Pittsburgh Sleep Quality Index (PSQI).
METHODOLOGY: In a randomized controlled trial involving 78 male and female subjects aged 60-80 with primary insomnia seen at the Family Medicine Clinic, three interventions were employed: Treatment A (Music Therapy), Treatment B (Sleep Hygiene) and Treatment C (Zolpidem). To determine improvement in sleep quality, subjects answered the PSQI questionnaire at baseline and at 14 days after intervention. Comparison of the mean scores before and after intervention and the mean change in the Global PSQI and its sleep components was done to assess the efficacy of music therapy. An intention to treat analysis was done.
RESULTS: Of the 90 participants enrolled, 78 completed the treatment protocol (Sleep hygiene = 27, Zolpidem = 24 and Music therapy = 27). Twelve were lost to follow-up. Baseline characteristics showed no significant differences among the three interventions in terms of age, gender, marital status, education, concomitant illnesses and insomnia severity. After 14 days of intervention, significant improvement in sleep quality with regard to 4 important parameters (latency, duration, efficiency, overall sleep quality) was consistently found in all the three intervention groups (p <.05). A two week music therapy regimen increased sleep duration from 5.19 +/- 1.24 hours to 6.0 +/- 1.08 hours (p = .007). For all the three interventions, time to sleep onset significantly decreased from baseline (p = .000). Music therapy for two weeks significantly reduced the amount of sleep from 65.1 +/- 48.7 minutes to 32.7 +/- 12.9 minutes (p = .000). Overall subjective sleep quality rating improved across the three regimens (p < .05). For Music therapy, sleep quality rating improved from 1.48 +/- 0.72 to 0.71 +/- 0.46 post intervention (p = .000). Furthermore, music therapy is better than zolpidem in terms of subjective sleep quality (p = .017). Scores on the Global PSQI showed that there is no statistically significant difference between the Sleep hygiene and Zolpidem groups (p = .622), between the Sleep hygiene and Music therapy groups (p = .989) and between the Zolpidem and Music therapy groups (p = .540).
CONCLUSION: This controlled study conveys that music therapy is as efficacious as pharmacologic therapy and sleep hygiene in improving sleep quality. Instituting music therapy for 14 days improved sleep latency, duration, efficiency and overall sleep quality. It provided promising effect as a short term management alternative to primary insomnia. Its sustained effect has to be investigated.